Everyone agrees that inappropriate and unnecessary medical care is bad and a waste of money, but the process of prior authorization (that is designed to solve those problems) is about as well-liked as a Batman villain. Health plans will not pay for certain healthcare services or products unless providers can prove, through the prior authorization process, that the recommended care is necessary, appropriate, and cost-effective. But like the Riddler in the latest Batman movie, the prior authorization process subjects providers and patients to a maddening number of questions before the desired goal may be reached. To address this slow and burdensome process, both the public and private sector have raised the call to automate the prior authorization process. This week, a public-private committee of experts offered its recommendations to HHS about what has to happen to solve the riddle of creating an electronic prior authorization process. Clearly, this will be a long series of staged rollouts to implement the new process, but spoiler alert: the prior auth Riddler will be foiled and it is no Joker.
March 11, 2022 | 2 min read
March 11, 2022
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